Spectrum of acute kidney injury in intensive care unit: a single centre experience

Background: Acute kidney injury (AKI) in the intensive care unit (ICU) is associated with high mortality. A thorough understanding of the clinical spectrum of the disease is needed in order to device methods to improve the final outcome due to this problem. Aims and Objectives: The aim of present study was to analyze the clinical spectrum, causes, risk and prognostic factors and final outcome of AKI in the setting of ICU. Materials and Methods: This prospective study involved patients admitted to ICU during the period between June 09 to June 10. Patients who developed AKI during the ICU stay were included in the study. The clinical and laboratory data were collected at admission and then on daily basis. Data recorded includes patients demographic profile, underlying clinical illness responsible for ICU admission, dialysis requirement, need for ventilation, total duration of ICU stay, acute physiology and chronic health evaluation (APACHE)-IV score and final outcome and these data were analyzed for predicting survival using univariate and multivariate analysis. Results: 574 patients were admitted to ICU from June 09 to June 10 and (n = 124; 21.6%) patients developed AKI after admission to ICU. Mean age 44.87 ± 15.14 years and (n = 71; 57.1%) were males and (n = 53; 42.9%) were females. Out of 124 patients (50.80%; n = 63) had medical, (33.87% n = 42) had surgical and (15.32%; n = 19) had obstetric cause of admission in ICU. Of the 574 patients (12.02%; n = 69) had associated co morbidities, hypertension is the most common associated morbidities (4.7%; n = 27), others were diabetes mellitus (3.6%; n = 21), coronary artery disease (3.0%; n = 17), cerebrovascular disease (0.3%; n = 2), chronic obstructive pulmonary disease (0.3%; n = 2;). The etiology of AKI was multi-factorial, sepsis were the most common cause observed in (69.64%; n = 39), hypotension (67.84%; n = 38), volume depletion (19.64%; n = 11), nephrotoxic drugs (64.28%; n = 36) patients. Multi organ system failure (MOSF) was noted in (29.03%; n = 36) patients. MOSF and sepsis were found to be significant adverse prognostic factors when multiple logistic regression analysis was done. Conclusion: AKI was seen in 21.6% of cases in our ICU and associated with poor prognosis. Presence of sepsis, MOSF, higher APACHE IV scores and ventilation requirement were correlated with higher mortality in AKI patients in ICU. Early recognisition and intervention improves the outcome.

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Acute kidney injury-incidence, prognostic factors, and outcome of patients in an Intensive Care Unit in a tertiary center: A prospective observational study

Indian Journal of Critical Care Medicine ◽

10.4103/0972-5229.183904 ◽

2016 ◽

Vol 20 (6) ◽

pp. 332-336 ◽

Cited By ~ 6

Author(s):

Shyam Sundar ◽

Sara Korula ◽

Sindhu Balakrishnan ◽

Vergis Paul ◽

Anuroop Balagopal

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Prognostic Factors ◽

Observational Study ◽

Prospective Observational Study ◽

Kidney Injury ◽

Injury Incidence ◽

Tertiary Center

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Acute Kidney Injury and COVID-19: A Picture from an Intensive Care Unit

Blood Purification ◽

10.1159/000513153 ◽

2021 ◽

pp. 1-5

Author(s):

Francesco Alessandri ◽

Valentina Pistolesi ◽

Chiara Manganelli ◽

Franco Ruberto ◽

Giancarlo Ceccarelli ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Renal Function ◽

Intensive Care ◽

Respiratory Failure ◽

Kidney Injury ◽

Icu Mortality ◽

Icu Stay ◽

Renal Function Recovery ◽

Tertiary Teaching

Introduction: Acute kidney injury (AKI) is a frequent complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care unit (ICU) for severe respiratory failure. The aim is to evaluate the rate of AKI, defined according to Kidney Disease: Improving Global Outcome guidelines, in a series of critical COVID-19 patients admitted to the ICU of a single tertiary teaching hospital. Methods: From April to May 2020, all consecutive critically ill COVID-19 patients admitted to the ICU who did not meet exclusion criteria (length of ICU stay <48 h, ESRD requiring dialysis, and patients still hospitalized in ICU at the time of data analysis) were enrolled in this study. Patients were stratified according to the highest AKI stage attained during ICU stay. Results: Sixty-one patients were included in the analysis. AKI was observed in 35/61 patients (57.4%): 25/35 episodes (71.4%) were observed within the first 7 days. AKI was classified as follows: 17.1% stage 1, 25.7% stage 2, and 57.2% stage 3. Fourteen out of 20 stage-3 patients required continuous renal replacement therapy (CRRT), mostly related to persistent oliguria. The overall ICU mortality was 68.9%, and it was higher in patients developing AKI if compared to no-AKI patients (p = 0.006). Renal function recovery of any grade was observed in 14 out of 35 AKI patients (40%). Among patients undergoing CRRT, 13 patients were still dialysis dependent at the time of death. Conclusion: In critical COVID-19 patients, ICU mortality is particularly high, especially in patients developing AKI. An accurate monitoring of renal function in early phases of respiratory failure should be ensured in order to timely apply any strategy aimed at limiting renal complications during ICU stay.

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Incidence and predictors of delirium on the intensive care unit in patients with acute kidney injury, insight from a retrospective registry

Scientific Reports ◽

10.1038/s41598-021-96839-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Markus Jäckel ◽

Nico Aicher ◽

Jonathan Rilinger ◽

Xavier Bemtgen ◽

Eugen Widmeier ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Kidney Injury ◽

Stage I ◽

Stage Ii ◽

University Hospital ◽

Psychiatric Disease ◽

Daily Routine ◽

Icu Stay

AbstractAcute kidney injury (AKI) and delirium are common complications on the intensive care unit (ICU). Few is known about the association of AKI and delirium, as well as about incidence and predictors of delirium in patients with AKI. In this retrospective study, all patients with AKI, as defined by the KDIGO (kidney disease improving global outcome) guideline, treated for more than 24 h on the ICU in an university hospital in 2019 were included and analyzed. Delirium was defined by a NuDesc (Nursing Delirium screening scale) ≥ 2, which is evaluated three times a day in every patient on our ICU as part of daily routine. A total of 383/919 (41.7%) patients developed an AKI during the ICU stay. Delirium was detected in 230/383 (60.1%) patients with AKI. Independent predictors of delirium were: age, psychiatric disease, alcohol abuse, mechanical ventilation, severe shock, and AKI stage II/III (all p < 0.05). The primary cause of illness had no influence on the onset of delirium. Among patients with AKI, the duration of the ICU stay correlated with higher stages of AKI and the presence of delirium (stage I/no delirium: median 1.9 (interquartile range (25th–75th) 1.3–2.9) days; stage II/III/no delirium: 2.6 (1.6–5.5) days; stage I/delirium: 4.1 (2.5–14.3) days; stage II/III/delirium: 6.8 (3.5–11.9) days; all p < 0.01). Delirium, defined as NuDesc ≥ 2 is frequent in patients with AKI on an ICU and independently predicted by higher stages of AKI.

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Acute kidney injury

Challenging Concepts in Paediatric Critical Care ◽

10.1093/med/9780198794592.003.0009 ◽

2020 ◽

pp. 105-114

Author(s):

Reshma Bholah ◽

Timothy E. Bunchman

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Prognostic Factors ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Made In

Acute kidney injury (AKI) affects roughly one-quarter of children in the Intensive Care Unit and is associated with increased morbidity and mortality. Progress made in classifying paediatric AKI has allowed for better recognition of this entity. Consideration of degree of fluid overload and other risk factors for mortality should influence the choice to initiate renal replacement therapy. And while not all patients with AKI will require renal replacement therapy, the modality needs to be chosen carefully. This book chapter aims to describe AKI, provide a brief overview of the aetiology and diagnosis of this process, describe biomarkers under study for diagnosing AKI, compare the modalities of renal replacement therapy, and touch upon prognostic factors and recent advances in the field.

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Microalbuminuria can predict the development of acute kidney injury in intensive care unit admission

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20203601 ◽

2020 ◽

Vol 7 (9) ◽

pp. 1372

Author(s):

Bharath G. ◽

Prasanna Kumar ◽

Mahendra S. V.

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Statistical Significance ◽

Prognostic Significance ◽

Kidney Injury ◽

Common Finding ◽

P Value ◽

Icu Patients ◽

Icu Stay

Background: Microalbuminuria, defined as 30–300 mg/day of albumin excretion in urine is a common finding in ICU patients and has shown not only as a predictor of organ failure but prolonged intensive care unit (ICU) stay. Objective of the study was to determine the prediction of acute kidney injury using urine microalbuminuria and to determine the presence of urine microalbuminuria and relationship between ICU length of stay.Methods: The present study is conducted on patients admitted to Medical ICU in SDMCMSH, Dharwad from December 2016 to November 2017. 75 patients who met the inclusion and exclusion criteria were included in the study.Results: The present study included 75 patients, among which 50 were males and 25 were females. The mean age was 60.2years. AKI was developed more in non-diabetics than diabetics and non-hypertensives than hypertensives. The median urine microalbumin at admission in AKI was 80.9 and at 48 hr was130.1 predicted the AKI mean (1.79) in 59 patients with a p value of <0.001 using Mann Whitney test and P value statistically significant.Conclusions: Urine microalbuminuria at 48 hr has predicted AKI in 59 patients with median of 130.1 with statistical significance. Urine microalbuminuria of high value in AKI is directly proportional to prolonged ICU stay. At 48 hours of admission, increased levels of microalbuminuria compared at admission and 48 hour, indicates its prognostic significance among AKI and NON-AKI’s in ICU patients.

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